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GOP Health Bill Could Let Insurers Cap Spending On Expensive Patients

ARI SHAPIRO, HOST:

Senate Republicans' plan to overhaul¹ the Affordable² Care Act could allow states to redefine what is covered by health insurance, and that could mean returning to the days of lifetime limits. Those were caps on how much insurers might have paid for certain expensive patients. Alex Olgin from member station WFAE introduces us to a 6-year-old who this bill might affect.

ALEXANDRA OLGIN, BYLINE³: These days, 6-year-old Clara Hardy⁴'s biggest struggle is holding her breath long enough to touch the bottom of the neighborhood pool.

CLARA HARDY: OK, ready, Dad?

ROBERT HARDY: (Laughter) OK.

OLGIN: But immediately after she was born in 2011, she couldn't even breathe. She had a serious birth defect called a congenital diaphragmatic hernia. As she explains it...

CLARA: On day eight, the surgeons cut me open. Everything that was in my chest got back to my belly⁵. They put a patch to fix the hole in my diaphragm.

OLGIN: Clara reads her story from a construction-paper book she wrote and illustrated⁶ in crayon with a little bit of help from Mom, Chrissy.

CHRISSY HARDY: We were told more than once that she would not survive.

OLGIN: But after many procedures that Christie says cost more than a million dollars, she finally got to cradle her baby.

C. HARDY: She was born two months before I turned 30, and we held her for the first time on the day before my 30th birthday.

OLGIN: At the time, she had health insurance through her job as a public school teacher. So the family's out-of-pocket costs were just $10,000. But under the GOP proposal, the Hardys could be on the hook for a lot more. The bill gives states wiggle room on Obamacare's essential health benefits, and that leaves the door open to insurers to charge more and even bring back lifetime caps on how much they'd pay. The details are up in the air, but Clara's dad, Robert, is worried.

R. HARDY: I don't really know what that limit would be, but there's a very good chance that she's probably already hit it.

OLGIN: The Affordable Care Act bans insurers from imposing⁷ lifetime caps on expensive patients. Matt Fiedler is with the Brookings Institution. He warns that if the GOP bill passes, the problem of lifetime limits could spread quickly because large companies that offer health insurance could choose the essential health benefits from whatever state they want.

MATT FIEDLER: If you are an employer with, say, 150 employees - so you're buying large, group market coverage⁸; you're entirely⁹ in Pennsylvania - you can choose Mississippi's definition of essential health benefits for the purposes of the lifetime limit provision.

OLGIN: For people buying plans from the exchanges, they're likely limited to what their state is willing to cover, says Fiedler.

FIEDLER: If a benefit were no longer a central health benefit, you would probably not have plans that offered that type of coverage without an annual or lifetime limit. So it's just - people would just have no place to go.

OLGIN: And that effectively guts¹⁰ protections for pre-existing conditions. The Hardys now got insurance through the exchange which they got despite Clara's past health problems. But Robert Hardy is worried that he may end up footing a substantial portion of future medical expenses Clara could incur¹¹ because of her past health problem.

R. HARDY: I would like to be able to be in a situation where I knew that I didn't have to worry if I was going to face a decision to bet my financial security against my child's health.

CLARA: The doctors thought I would die, but I didn't.

OLGIN: As Clara reads her book, she lifts her pink shirt a little to show me a scar that cuts diagonally across her entire stomach.

CLARA: My scar on my tummy makes me proud. It is a reminder¹² that I am tough and I can do hard things.

OLGIN: For NPR News, I'm Alexandra Olgin in Clemmons, N.C.

(SOUNDBITE OF TORO Y MOI SONG, "SAY THAT")

1 overhaul   

v./n.大修，仔细检查

参考例句：

• Master Worker Wang is responsible for the overhaul of this grinder.王师傅主修这台磨床。
• It is generally appreciated that the rail network needs a complete overhaul.众所周知，铁路系统需要大检修。

2 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 hardy   

adj.勇敢的，果断的，吃苦的；耐寒的

参考例句：

• The kind of plant is a hardy annual.这种植物是耐寒的一年生植物。
• He is a hardy person.他是一个能吃苦耐劳的人。

5 belly   

n.肚子，腹部；(像肚子一样)鼓起的部分，膛

参考例句：

• The boss has a large belly.老板大腹便便。
• His eyes are bigger than his belly.他眼馋肚饱。

6 illustrated   

adj. 有插图的，列举的 动词illustrate的过去式和过去分词

参考例句：

• His lecture was illustrated with slides taken during the expedition. 他在讲演中使用了探险时拍摄到的幻灯片。
• The manufacturing Methods: Will be illustrated in the next chapter. 制作方法将在下一章说明。

7 imposing   

adj.使人难忘的，壮丽的，堂皇的，雄伟的

参考例句：

• The fortress is an imposing building.这座城堡是一座宏伟的建筑。
• He has lost his imposing appearance.他已失去堂堂仪表。

8 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

9 entirely   

ad.全部地，完整地；完全地，彻底地

参考例句：

• The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
• His life was entirely given up to the educational work. 他的一生统统献给了教育工作。

10 guts   

v.狼吞虎咽，贪婪地吃，飞碟游戏（比赛双方每组5人，相距15码，互相掷接飞碟）；毁坏（建筑物等）的内部( gut的第三人称单数 )；取出…的内脏n.勇气( gut的名词复数 )；内脏；消化道的下段；肠

参考例句：

• I'll only cook fish if the guts have been removed. 鱼若已收拾干净，我只需烧一下即可。
• Barbara hasn't got the guts to leave her mother. 巴巴拉没有勇气离开她妈妈。 来自《简明英汉词典》

11 incur   

vt.招致，蒙受，遭遇

参考例句：

• Any costs that you incur will be reimbursed in full.你的所有花费都将全额付还。
• An enterprise has to incur certain costs and expenses in order to stay in business.一个企业为了维持营业,就不得不承担一定的费用和开支。

12 reminder   

n.提醒物，纪念品；暗示，提示

参考例句：

• I have had another reminder from the library.我又收到图书馆的催还单。
• It always took a final reminder to get her to pay her share of the rent.总是得发给她一份最后催缴通知，她才付应该交的房租。